CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Rush Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $225
Cash Discount Price: $1,885
vs. Medicare Baseline: 0.18x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Rush Memorial Hospital is $225. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,885. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.18x the Medicare baseline. Located in 1300 N Main St, Rushville, IN.

Cash / Self-Pay

$1,885

Average discount available for prompt cash payment at this facility.

Insurance Median

$225

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$1,222.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $1,222.56 (100%)

Cash / Self-Pay: $1,885 (154%)

Insurance Median: $225 (18%)

Cash: $1,885 (154% of Medicare)

Ins. Median: $225 (18% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $1,222.56 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
UnitedHealthcare	$145 - $167	12%
Caresource Mcr Adv	$167	14%
Aetna	$169 - $195	14%
Humana	$169 - $180	14%
Blue Cross Blue Shield	$172 - $623	14%
Today'S Option Mcr Adv-All Plans	$172	14%
Viant Beech St Mcr Adv	$172	14%
My True Advantage - All Plans	$175	14%
Consumers Life Ins-All Plans	$195	16%
Caresource Marketplace-All Other Plans	$225	18%
Phcs-All Plans	$294	24%
Multiplan-All Plans	$654	53%
Encore Health Services-All Plans	$712	58%
Siho-All Plans	$712	58%
Cigna	$1,256	103%
Health Net	$1,256	103%
Coventry/First Health-All Plans	$1,759	144%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,885.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45380.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Rush Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45380.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.